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OPTUM PHARMACY 705, LLC
CAH251318-01 NORTH SUNFLOWER MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH SUNFLOWER MEDICAL CENTER
Subdivision Name
SUNFLOWER RURAL HEALTH CLINIC
Type
Critical Access Hospital
340B ID
CAH251318-01
Entity Address
840 NORTH OAK AVENUE
RULEVILLE, MS 38771
Medicare Provider Number
251318
Outpatient Facility Provider Number
253400
Participating Start Date
9/16/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sam Miller, Chief Executive Officer
(662) 721-0186
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2022
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